MSNBC: U.S. military heavily medicated *

He opened his eyes, but saw nothing. It was the middle of the night, and he was facedown in the sands of western Iraq. His loaded M16 was pinned beneath him.

Cataldi had no idea how he’d gotten to where he now lay, some 200 meters from the dilapidated building where his buddies slept. But he suspected what had caused this nightmare: His Klonopin prescription had run out.

His ordeal was not all that remarkable for a person on that anti-anxiety medication. In the lengthy labeling that accompanies each prescription, Klonopin users are warned against abruptly stopping the medicine, since doing so can cause psychosis, hallucinations, and other symptoms. […] the drug’s adverse effects endangered lives — his own, his fellow Marines’, and the lives of any civilians unfortunate enough to cross his path.

“It put everyone within rifle distance at risk,” he says.

In deploying an all-volunteer army to fight two ongoing wars, in Iraq and Afghanistan, the Pentagon has increasingly relied on prescription drugs to keep its warriors on the front lines. […] many of those service members are then sent back to war theaters in distant lands with bottles of medication to fortify them.

Data from the Department of Defense last fall showed that as of September 2007, prescriptions for narcotics for active-duty troops had risen to almost 50,000 a month, compared with about 33,000 a month in October 2003, not long after the Iraq war began.

In other words, thousands of American fighters armed with the latest killing technology are taking prescription drugs that the Federal Aviation Administration considers too dangerous for commercial pilots.

Cataldi […]

When he returned to his stateside base at Twentynine Palms, California, he knew he’d brought more than memories back from Iraq.

“It scared the crap out of me,” he says.

He went to see a psychiatrist on base. “He said, ‘Here’s some medication,’ ” Cataldi recalls. The prescribed drugs were Klonopin, for anxiety; Zoloft, for depression; and Ambien, to help him sleep.

Later, other military doctors added narcotic painkillers for the excruciating pain in his leg, which he’d injured during a training exercise […] Those prescriptions didn’t stop the Marine Corps from sending Cataldi back to Iraq. In 2006, he returned to the same part of the Iraqi desert to do the same job […] He also took his turn driving the 14-ton tanklike vehicles, one of which was armed with a 25 mm cannon and two machine guns and loaded with more than 1,000 rounds of ammunition.

Cataldi says he managed on the medications — until his Klonopin ran out. The medical officer told him there was no Klonopin anywhere in Iraq. So the officer gave him a drug called Seroquel. That’s when Cataldi says he started to become “loopy.”

“I’d go to pick up a wrench and come back with a hammer,” he says.

Soldiers on medication

During the Vietnam war, military psychiatrists spoke enthusiastically about some newly psychiatric medicines, including Thorazine, an anti-psychotic, and Valium, for anxiety. According to an army textbook, doctors frequently prescribed those drugs to soldiers with psychiatric symptoms.

Critics of medication use in Vietnam also said that a soldier traumatized by battle may not be coherent enough to give his consent to take the drugs in the first place. Plus, a soldier would risk court-martial if he refused to follow orders, they said, making it unlikely he could make a reasoned decision about taking the medications.

Colonel Elspeth Cameron Ritchie, M. D., M. P. H., a psychiatrist and the medical director of the strategic communication directorate in the Office of the Army Surgeon General, acknowledges that writing more prescriptions for frontline troops was a change in direction for the Pentagon.

Today it’s not uncommon for a soldier to arrive in Iraq while taking a host of prescription drugs. The Pentagon explained its new practice in late 2006, stating that there are “few medications that are inherently disqualifying for deployment.”

Military physicians consider antidepressants and sleeping pills to be especially helpful, she says. Doctors have also found that small doses of Seroquel, an anti-psychotic, can help treat nightmares, she says, even though the drug is not approved for that use.

In an article in the journal Military Medicine, Jeffrey Hill, M. D., and his colleagues wrote about soldiers who had made suicidal or homicidal threats at a base in Tikrit, Iraq. Of 425 soldiers evaluated for psychiatric treatment, they reported, about 30 percent had considered killing themselves in the previous week, and 16 percent had thought about killing a superior or someone else who was not the enemy.

Each of these soldiers poses a dilemma for physicians, they wrote, because of his or her duty “to conserve the fighting strength” — the motto of the U. S. Army Medical Department. Doctors must try to avoid sending these soldiers home,

When Travis Virgadamo arrived from his army unit in Iraq for a visit with his family in July 2007, he hesitated to tell his grandmother, Katie O’Brien, what he had seen. “‘I’ve seen little children killed,’” she remembers him saying. “‘You can’t imagine what it’s like, Grandma. You just can’t.’”

One day as men in his unit were cleaning weapons, the commander sent Virgadamo for some gun oil, O’Brien says. When he didn’t return, they went to look for him. They found him with a gun in his mouth.

Virgadamo was sent home to Pahrump, Nevada, to be with his family for 10 days. Then he would be returned to Iraq. O’Brien learned that he was sent to a class meant to help him, and that he had been given a new medication instead of Prozac. The day he supposedly completed his class, O’Brien says, his commander gave him his gun back.

That night he used it to kill himself.

She is furious that the army gave him Prozac. She points out that the labeling of Prozac, Zoloft, and similar antidepressants state that the drugs have been shown to increase suicidal behavior in people age 24 and younger — a group that includes large numbers of American soldiers.

age 26, with a new wife and child, Michael R. De Vlieger

evacuated by helicopter and returned to Fort Campbell, in Kentucky, to recuperate. But his personality had changed. He began to drink heavily, and flew into rages. One day, he attacked his wife’s dog.

“I had lost so many friends and went through a near-death experience,” he says. “I wasn’t who I was when I left.”

He was updating his will and preparing to return to Iraq when he broke down. His wife, Christine, found him awake in the middle of the night, rocking while babbling incoherently. Frightened, Christine called his squad leader, who took him to the base emergency room. Doctors then sent him to a nearby private psychiatric hospital, where he stayed for 16 days, receiving medications to calm his panic and treat his blood pressure and depression. The doctors released him with four prescriptions.

A noncommissioned officer in charge of De Vlieger’s unit’s stateside operations told him that day that he had to leave immediately for Iraq. Less than 18 hours after being released from the hospital, De Vlieger was on a plane heading for the Middle East. “I was in no condition to leave,” he says. “I’m an infantryman. If I’m screwed up in my head, it could cost my life or the lives of the men with me.”

Pentagon policy requires that service members with psychiatric conditions be stable for at least 3 months before they can be deployed.

DeVlieger says the medications altered his thinking — a side effect he didn’t want to deal with at war. He threw the pills away.

“I had a weapon, entire magazines filled with rounds. It’s not like it would have been difficult for me to commit suicide,” he says. “I don’t believe it was safe.”

Military physicians can be swayed by the aggressive promotional efforts of the pharmaceutical industry just like civilian doctors often are.

When thousands of military and federal health-care professionals met in November for the annual meeting of the Association of Military Surgeons of the United States (AMSUS), more than 80 pharmaceutical companies and other health-care firms were on hand. The companies helped pay for that San Antonio event

The 6-day meeting included a celebration; 15 military and federal doctors and other health professionals received awards that included cash prizes provided by various drug companies.

Aggressive corporate promotion is one reason behind the army’s fast-rising use of narcotic painkillers. Manufacturers of narcotics like OxyContin and Actiq have spent millions in recent years to convince doctors that the drugs aren’t as addictive or as dangerous as most people believe. Before such corporate marketing campaigns, many doctors hesitated to prescribe narcotics unless a patient was suffering from a serious, pain-inflicting condition — terminal cancer, for instance. Drugmakers expanded the market by encouraging docs to prescribe narcotics to people suffering from more moderate pain, and by downplaying the drugs’ addictive potential.

These same manufacturers fund organizations like the American Pain Society. The society’s noble goal of eliminating pain has made it the perfect conduit for drug marketing.

The army has plenty of firsthand evidence of how addictive the painkillers can be. At Fort Leonard Wood, in Missouri, officials charged more than a dozen soldiers with illegally using and distributing narcotics, including drugs they’d reported picking up at the base’s pharmacy for little or no cost. Many of the soldiers had suffered injuries in Iraq or in training but had later begun abusing the painkillers reportedly prescribed by army doctors.

A soldier taking a narcotic can start using it to escape more than his pain.

Cataldi, who’s now out of active duty, says that when he returned from his first tour of Iraq, both he and a friend were taking painkillers for injuries. They couldn’t seem to get enough of the drugs, he says.

“We’d find pills on the floor,” he says, “and just take them.”

Narcotics can make patients dizzy and unable to function. Their labels warn about performing “potentially hazardous tasks.”

Staff Sergeant Jack Auble took Oxy-Contin, Percocet, and Vicodin for a serious back injury as he worked in Camp Stryker, in Baghdad. Prior to that tour, he had been in the process of being medically discharged from the army after 20 years of service because of severe osteoporosis in his spine. Then he was sent to Iraq.

Auble’s job in Baghdad was to monitor a computer that showed in real time what was happening on the battlefield. But the side effects of the drugs made his job impossible, he says. He frequently lost track of what people said to him and the positions of troops in the field.

“I could not do the job,” Auble says. “My judgment was clouded all the time.”

After 3 months in Baghdad, Auble’s pain worsened. The army evacuated him to a hospital outside Iraq. At 44, he is now retired with a permanent disability, and walks with a cane.

[…] Cataldi. He shows a visitor snapshots taken at the funerals of some of his buddies. He goes to the kitchen, bringing back four bottles of medications, including Klonopin, the drug he blames for creating a needless ordeal in Iraq. He fears he’ll be on Klonopin for the rest of his life. When he tries to stop taking it, he spaces out and isolates himself.

“If I had never been put on medications and just had counseling, I’d be a lot better off ,” he says.